sydney safety confined space rescue plan on site rescue plan is part of the confined space entry...

SYDNEY SAFETY TRAINING 395 Guildford Road GUILDFORD NSW 2161 Ph 9892 3370 "training to create a safer workplace"

Confined Space Rescue Plan

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Reason for entry: Work activity description:

Nature of work to be undertaken:

Confined space to be entered: Description:

Location: Potential hazards:

Entry Permit Supervisor Name:

Rescue Personnel: Rescue team: Name: Employer: Date: Name: Employer: Date: Name: Employer: Date:

Communication Controls: Minimum requirements will include: Yes No Provide details as required: One stand-by person Two/more stand-by personnel Rescue team Communication via voice/direct sight Communication via two way radio Communication via hand signals Communication via rope signal Mobile phone available to ring emergency services

Rescue / Retrieval Considerations: Minimum provisions required: Yes No Provide details – Specifically for Complex Scenarios: Stand-by person to individually handle Safety harness/rescue kit in vicinity with competent user(s)

Specific access platforms/scaffolding erected Specific fire fighting provisions First aid kit in vicinity Other:

Personal Protective Equipment (PPE) Requirements & Other Precautions Minimum PPE / other items required: Yes No Provide details as required: Supplied air breathing apparatus Air purifying respirator Particulate mask Safety harness and lanyard/lifeline Head protection/Foot protection Face shield/goggles/safety glasses Ear muffs/plugs Gloves Warning notices / barricades required Specific lighting provisions required Specific hot work permit required Other: Attachments (other documents/plans prepared)



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Methods of Rescue Requirements can include: Yes No Provide details as required: External (Retrieval) Internal: with SCBA without SCBA Anchorage: Tripod Beam Stairwell Support Strut/Column Overhead The atmosphere in the space is safe to enter: Without respiratory protection With an air purifying device With a supplied-air device

Rescue Equipment requirements Requirements can include: Yes No Provide details as required: Harnesses Tripod Rescue System Main Lines Safety Lines Carabiners Shock absorbers/Lanyards Gas Detector Other: Rescue Equipment inspected by: Identified rescue equipment inspected by a competent person: Name: Employer: Date: Name: Employer: Date: First Aid personnel: First Aid personnel : Name: Employer: Date:

Name: Employer: Date: Principal Contractor’s Authorisation: This Authorisation signifies that the rescue plan component of the Confined Space entry has been completed and that confined space entry / work is authorised to commence in accordance with the Permit Request. Name: Signature: Date: Time: Rescue Team Personnel I the undersigned hereby acknowledge that I understand my role, the procedures, control measures and precautions to be observed with the rescue plan for this confined space. I will comply with these requirements at all times and report any new/unforeseen hazard that presents a risk to the safety of all personnel involved with this task. Sign on Sign Off Print Name (First & Last) Date Time Signature Date Time Signature



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Description of Space Include location of Entry Permit Supervisor and Stand by person:

Diagram of Space Show locations of all personnel involved in task:



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ON SITE RESCUE

The On Site Rescue Plan is part of the Confined Space Entry Permit and is based on the assessment of hazards in the space. Prior to entry and/or work in the Confined Space:

The Entry Permit Supervisor will ensure that the on-site rescue plan for the confined space has been completed and that all the rescue equipment identified in the plan is available to effect a rescue in the confined space.

The Entry Supervisor will ensure that an adequate number of appropriately trained personnel (as documented in the rescue plan) are available for immediate implementation of the rescue if so required.

The Entry Supervisor will ensure that all personnel in the rescue team, understand and know their roles and

responsibilities and have signed the rescue plan prior to any personnel entering the confined space. Ensure everyone is aware of the evacuation alarm.

The Stand by person must establish communication with all workers (inside and outside of the confined space)

using the means described in the rescue plan.

On entry and while working in the Confined Space:

The Stand by person who is stationed outside and near the entrance to the confined space as shown in the rescue plan, remains in constant communication with all workers inside the confined space.

The Stand by person must be notified immediately if an entrant recognises: Unusual action or behaviour An unexpected hazard An unsafe act Detects a condition prohibited by the permit

Personnel must exit the confined space as quickly as possible, when:

An order to evacuate is given by the Entry Permit Supervisor or the Stand by person An entrant recognises a sign or symptom of exposure An unacceptable condition arises An evacuation alarm is activated

In the event of a confined space rescue:

The Entry Permit Supervisor or the Stand by person do not enter the confined space but immediately summons a rescue response from the on-site rescue team. A nominated person must inform emergency services immediately if required. If injured person is able to be extracted, assess the persons injuries and provide assistance and first aid as necessary.

sydney safety confined space rescue plan on site rescue plan is part of the confined space entry...

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